McLeod and Ameuille13 conclude that the disease is due to deficiency of certain elements in diet and to the consumption of excessive protein. They think that his is the most likely explanation of transient albuminuria, and that it may contribute towards the development of the more severe cases. They are supported by Gaud and Maurice,14 who consider that fatigue and deficient food elements are the most important factors in the causation of war nephritis.
In the face of so many conflicting facts and theories regarding the epidemiology of this disease, it may safely be said that the cause is still unknown.
The possible infective nature of nephritis is suggested by the following points; there is frequently a febrile onset; the disease, according to Abercrombie,8 relapses in about 2 per cent. of cases, which is one of characteristics of protozoal infections; the slightly raised eosinophile count and the marked increase in large mononuclears support this hypothesis. Rose Bradford15 and also Pick4 have drawn attention to the comparative immunity of officers to war nephritis, and the former has also reported the completed immunity of the Indian troops to the disease. The Indian troops suffered from all other war diseases, including bronchitis, but not from nephritis.
These facts suggest that British officers and Indian troops share something in common, or avoid something equally, which influences the onset of war nephritis. In the British Army officers and men at the front line live under almost similar conditions: all drink from the same water supplies; all breathe the same polluted air and live under the same unpleasant conditions. The officers do, however, eat fresh food. Even in the trenches during the Somme battle salads and fruit were seen in officers dug – outs. When out at rest officers buy fresh food and vegetables and are able often to obtain new milk; in other words, they supplement their rations.
This applies equally well to officers living on the lines of communication or at the base; probably they have a “ration mess,” but certainly they supplement their rations with fresh food. The soldier, however, does not do this. He draws his rations, but has little or no opportunity, even if he desires to do so, of purchasing fresh eatables. The Indian troops were accustomed to eat fresh meat newly killed and not the frozen or canned meat of European troops. They had fresh milk and not the tinned variety. So, in common with British officers the native troops obtained fresh food.
It is perhaps a suggestive fact that in the urines of cases of beri – beri Hewlett and De Korte16 found a body similar in appearance to the endothelial cell. We, too, have found endothelial cells the urines of cases of beri – beri imported into France with Asiatic labor.
The haematuria of war nephritis, which is often persistent, is reminiscent of that which occurs in mild cases of scurvy. It is interesting to note that the majority of cases had been in this country, and restricted living rations, for about seven months. Experience of work with front – line battalions has impressed upon both of us the frequency of boils and skin eruptions, the scorbutic origin of which is suggested by their great improvement when a lime – juice ration was instituted.
The objection may possibly be raised that the maximum incidence of the disease corresponds with the summer weather and the fruit season; this is met by the fact fresh fruit and vegetables in France are beyond the financial resources or cooking abilities of the average solider.
Careful consideration of all the views discussed above leads us to think that war nephritis may be attributed to some error in metabolism due to dietary deficiency. Our own observations would suggest the possibility of this, although we feel that our hypothesis is as yet by no means proved.
The following most excellent article by Dr.Louis Fischer, taken from The Therapeutic Gazette for February 15, 1918, is confidently presented to our readers.
The homoeopathic prescriber can easily round out Dr.Fischers clinical pictures by adding the symptomatology of such valuable remedies as Calcarea carbonica, Calcarea phosphorica, Phosphorus, Silicea, etc.
Therapeutically, at least, from the standpoint of drugs, we certainly have the advantage here. Attention is herewith called to the use of such endocrinous preparations as Thyroid and Pituitary extracts. Homoeopathically given, as far as our present knowledge will permit, in potencies such as the 1x, 3x, 6x and 30th, these glandular extracts are producing highly encouraging results, and there are best of reasons for believing that their beneficial effects are in accordance with the law of similars.
Homoeopathic physicians should make a careful study of endocrinous therapy, and all endocrinous preparations should be subjected to thorough homoeopathic provings.
